| NPI | 1215049283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MS PT1120) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: DC PT870615) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |